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Dental Therapists Could Bridge Gaps in Dentist Access

If you’ve ever been to a doctor on a busy day, or needed to see a physician but didn’t want to be on a months-long wait list, you may have been treated in the interim by a nurse practitioner (NP). A nurse practitioner is an advanced practice registered nurse (RN) who has completed more advanced training than a standard RN has.  Similar to the NP license, the dentistry community in many states is considering adding a third level of dental practitioner, called a Dental Therapist- to their licensing structure. But though this seems like a great way to solve a dentistry shortage in many communities, the proposal is facing strong opposition from some dentists. We spoke to Dr. Stephen Hill of Allen, Texas about how dental therapists may or may not benefit the dental field.

A dental therapist is a dental practitioner that falls somewhere between a hygienist and a dentist. Dental therapists receive a bit more training than hygienists, allowing them to treat more complex dental issues than hygienists, but they have not completed enough training to be licensed as doctors. Dental therapists can do all the things a hygienist does- like clean the teeth, give fluoride treatments and take x-rays –  but they can also do things like dental extractions, fillings and crown replacements that a regular hygienist cannot.

The use of dental therapists (sometimes known as advanced dental hygiene practitioners) began in 2011 after the state of Minnesota expanded its dental education program in 2009 to make way for the dental therapist license. Today, Minnesota has 60 active dental therapists, and they’re making a big impact on the oral health of Minnesotans- especially those in rural or impoverished areas.  Thanks to the success of the dental therapist program in Minnesota, Vermont and Maine have followed suit, adding dental therapist licensing to serve their own populations. Much like Minnesota, Vermont and Maine’s populations are largely rural, and in many cases lower income. Prior to the addition of dental therapists to these states, many patients were forced to either suffer needlessly until they could travel to a dental practice or these patients had no choice but to be treated in an emergency room for something that could be easily corrected in a dental office were they able to accommodate the patient. Now, thanks to the dental therapist program, patients in these three states can be treated closer to home, and without a lengthy wait to be seen by the few local dentists who may be booked for months in advance.

With the success of the dental therapist license in these three states, the concept is gaining traction around the country, with another 11 states actively considering adding a dental therapist license program to their state. One such state is Texas, Hill’s home state. 

“Here in Texas, dental therapists will likely make a bigger impact in the smaller towns that line the border of Mexico than they do in my area,” Hill said. “If you look at the Federally Designated Health Professional Shortage for Dental Care map of Texas, it seems like nearly half the state is underserved in dental care the farther you get from the cities.” 

In fact, in some areas, patients can expect to travel several hours to reach a dentist or wait months to be seen. This may not seem like a big deal for an annual cleaning, but for a patient with an abscessed tooth or periodontitis, waiting months in agony can be a huge problem- one that could be easily fixed with the addition of a dental therapist.

Hill says the biggest issue he can foresee in adapting the dental therapist program is oversight of the practitioners. As it stands now in Minnesota, Vermont and Maine, dental therapists must have a licensed dentist present when completing any procedure beyond what a hygienist license allows. In order to do anything like fillings, crowns, or extractions, a dentist would need to be on the premises. For other procedures, like routine cleanings and x-rays, a dental therapist is free to travel to underserved communities and at the very least make a recommendation that a patient see a dentist or the dental therapist in their office. For procedures like root canals, orthodontics, and the treatment of periodontitis, a dentist must be directly responsible for the patient’s care and cannot hand-off care to a dental therapist. 

“As long as these dental therapists are acting in accordance with the law and under the supervision of a licensed dentist, they hold a great potential to help an awful lot of people in Texas and around the United States,” Hill said. 

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